|Basic Newborn Resuscitation: A Practical Guide - Revision (WHO - OMS, 1999, 33 p.)|
A survey of health care institutions in 16 developed and developing countries showed that there was often no basic equipment for resuscitating newborns, or that it was in poor condition and health personnel were not properly trained in newborn resuscitation.
According to WHO estimates, around 3% of the 120 million babies born each year in developing countries develop birth asphyxia and require resuscitation. It is estimated that some 900,000 of these newborns die as the result of asphyxia.
A single intervention - resuscitation - deals with the problem of birth asphyxia as it occurs.
The need for resuscitation should always be anticipated. Thus, every birth attendant should be skilled in newborn resuscitation, (including anticipation, preparation, timely recognition and quick and correct action) and should have the necessary equipment and supplies - clean and functioning - to be able to respond quickly and correctly when needed.
Every newborn should be first dried, wrapped in a dry cloth, and assessed for crying/breathing. If the newborn is not breathing, the airway should be opened by positioning the head correctly, the mouth and nose should be quickly suctioned and the lungs ventilated with the self-inflating bag via a soft fitted face mask. The effect of ventilation is assessed by observing the chest rise.
Minimum equipment and supplies for newborn resuscitation include a heat source (preferably a radiant heater) to prevent heat loss (if this is not available, prewarmed towels and an extra blanket can be used to cover the newborn), a mucus extractor for suctioning, a self-inflating bag of newborn size, two masks (for normal and small newborns) for ventilation, and a clock to assess time correctly.
Adequate ventilation is more important than additional oxygen; quick action with the bag and mask is more important than intubation. Therefore resuscitation can and should be initiated virtually anywhere, including those places where oxygen is not readily available. The choice of device for ventilation is not as important as how effectively it is used. The most common causes of failed resuscitation are failure to recognize the problem promptly, not reacting quickly enough and not ventilating effectively. Correct technique and assessment of the effectiveness of ventilation are critical.
Advanced procedures (chest compression, intubation, administration of oxygen, use of drugs) are needed only in a small proportion of cases. These procedures have strict indications and are beneficial only in specific circumstances and if carried out by an experienced person.
In reality, even the simplest equipment is frequently not available and skilled health workers are lacking. In many places only one birth attendant is normally present at the birth, dividing her attention between the mother and the newborn. In such circumstances, the birth attendant can properly carry out only a certain number of procedures in the limited amount of time available for resuscitation.
Basic resuscitation will not help all newborns but, done correctly, it will help most, even where only few resources and simple training are available.
The probability of sequelae is low if a newborn infant is resuscitated promptly and correctly and starts breathing spontaneously within 20 minutes. Whether resuscitation succeeds or fails will depend on anticipation, preparation, skills and functioning equipment, timely initiation and correct procedures. Delayed or ineffective action makes resuscitation more difficult and increases the risk of brain damage.
To provide basic newborn resuscitation for all newborns who need it, each health institution needs to introduce it as a practice, to maintain the skills of the staff and to ensure that functioning equipment and supplies are always available. At national level, legislation, standards, training courses and training material will help health workers to carry out the task.